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Home My WebLink About210404 BLUE STEEL REMODELING Blue Steel Remodeling LLC COI (1)ACaR"� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/18/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE (855) 222-5919 FAX A/C No Ext): A/C No): Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 E-MAIL support@nextinsurance.com ADDRESS: nextinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Next Insurance US Company 16285 EACH OCCURRENCE $1,000,000.00 INSURED INSURER B Blue Steel Remodeling LLC 2738 Xanadu St INSURER C INSURER D DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence $ Aurora, CO 80011 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2132848 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS -MADE FX1OCCUR DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence $ MED EXP (Any one person) $10,000.00 PERSONAL & ADV INJURY $1,000,000.00 A NXT4V9GYD3-00-GL 05/18/2021 05/18/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000.00 X POLICYF-] PRO- F LOC JECT PRODUCTS - COMP/OP AGG $1,000,000.00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE IDEDT RETENTION $ $ WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITY Y / N PER -7 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? H N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Each Occurrence: $10,000.00 A Contractors Errors and Omissions NXT4V9GYD3-00-GL 05/18/2021 05/18/2022 Aggregate: $20,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION Blue Steel Remodeling LLC 2738 Xanadu St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Aurora, CO 80011 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD INTERNATIONAL CODE COUNCIL Name: OFFICIAL RESULTS REPORT F11 -National Standard General Building Contractor (A) JacobJohannesen Candidate ID Address: 2738 Xanadu st Date: Aurora CO 80011 EXAMINATION RESULT: PASS ICNON164463 1 /14/2021 Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www PearsonVUE.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 387034305 Validation Number.• 1066850819 ♦SAI City of "� WheatRjdge COMMUNITY DEVELOPMENT 7500 W. 29th Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance 1, (print your name), Jake Johannesen verify that I am the sole owner or partner of (company name): Blue Steel which has no employees and is not required by the State of Colorado to carry workers' compensation insurance. I further state that if I hire contractors/subcontractors, they are in compliance with the State of Colorado Workers' Compensation insurance requirements, have obtained the required contractor's license from the City of Wheat Ridge and will be listed on the permit. Jake Johannesen Digitally signed by Jake Johannesen0 Signature: Date. 2022.04.15 9'.01 25-00'00' Date: 4/15/2022